Real-world direct medical costs and resource utilization of immune checkpoint inhibitors in advanced NSCLC with COPD: a multicenter cost-consequence analysis from Iraq

BACKGROUND: Immune checkpoint inhibitors (ICIs) are widely used as first-line therapy for advanced non-small cell lung cancer (NSCLC), but their high acquisition cost places substantial pressure on publicly funded healthcare systems. Real-world economic data in patients with coexisting chronic obstructive pulmonary disease (COPD) remain limited, particularly in resource-constrained settings. This study evaluated direct medical costs and healthcare resource utilization associated with ICI therapy in Iraqi patients with advanced NSCLC and COPD. METHODS: A multicenter real-world cost-consequence analysis was conducted at two public oncology centers in Iraq. Adults with advanced NSCLC and documented COPD receiving first-line ICI-based therapy were included. Direct medical costs and resource use were assessed over a six-cycle horizon using a micro-costing approach from the public healthcare system perspective. Outcomes were reported descriptively for atezolizumab-based (n = 50) and pembrolizumab-based (n = 39) regimens. RESULTS: Baseline characteristics were comparable. Immunotherapy acquisition accounted for most costs (94-97%). Mean per-patient cost was 13.3 million IQD (10,170 USD) for atezolizumab and 23.6 million IQD (18,059 USD) for pembrolizumab, while non-drug costs and response outcomes were similar. CONCLUSIONS: Short-term costs were driven mainly by drug acquisition price, with other resource use remaining stable, providing context-specific evidence for resource planning in public oncology system.